Grommets

Paediatric ENT Specialist Thomas Havas

Does your child need Insertion of Grommets?

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Professor Havas has completed the highest number of paediatric operations in Australia. You may either call us or use the "Book an Appointment" form to arrange an appointment to see him.

Insertion of grommets (or tympanostomy tubes) remains the most common ambulatory surgical procedure performed on children in Australia. It accounts for about twenty percent of day surgical procedures. By the age of three, it is estimated one out of every fifteen children (6.8%) will have grommets, increasing by more than two fold in those that attend day care.


What are Grommets?

Grommet in Children

Define Grommets: Grommets are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist despite antibiotic therapy. All of these conditions are encompassed by the generic term otitis media (middle ear inflammation), which is second in frequency only to acute upper respiratory tract infections as the most common illness diagnosed in children by health care professionals. Children younger than seven years are at increased risk of otitis media because of their immature immune systems, the poor functioning of the Eustachian tubes, (a slender tube connecting the middle ear to the back of the nose that normally ventilates the middle ear space and equalizes pressure with the external environment).

When children require surgery for otitis media with effusion (OME), the insertion of tympanostomy tubes is the preferred initial surgical procedure, with candidacy depending primarily upon the child’s hearing status, associated symptoms and the child’s developmental risk.


Why Grommets?

Placement of grommets significantly improves hearing, reduces effusion prevalence, may reduce the incidence of acute otitis media (AOM), and provide a mechanism for drainage and administration of topical antibiotic therapy for persistent AOM.

Additionally recent research indicates that grommets may also improve disease specific quality of life (QOL) for children with chronic OME, recurrent AOM, or both.

Grommets sequelae are common but are generally transient (otorrhea), or do not effect function (tympanosclerosis, focal atrophy, or shallow retraction pockets of the eardrum). Permanent tympanic membrane perforations, which may require repair, are seen in about two percent of children after the placement and extrusion of short-term tympanostomy tubes.


Care For Children With Grommets

After the myringotomy and insertion of tympanostomy tubes (grommets), the fluid in the middle ear is sucked out and the hearing should return to normal.

Grommets come in various sizes, and by and large the bigger the grommet, the longer it stays in. The average grommet stays in for about 6 months.

Most people recommend that water be excluded from the ear, although the evidence associated with water in the ear and infections is not strong. Another controversial in Australia is swimming. By and large, for surface swimming there is little evidence that getting water in the ear causes a significant increase in the number of infections and/or contributes the grommet coming out early. The consensus recommendation in Australia still remains:

  • No water in the ears when you bath or shower.
  • No water in the ears when you surface swim.
  • The use of a plug and a bathing cap if you are going to duck dive or go below the water.

Children usually are not aware of the grommets being in place. Parents need to be away of any discharge from the ear. If there is any snot coming out of the ear, it usually indicates that the outer ear or in the middle ear and an appropriate thing to do is to go and see your GP or ENT surgeon.